What do conservatives believe about health care?

Conservative strategist Patrick Ruffini has a searching and skeptical post on his party's approach to health-care reform. "On health care, I have no idea what our basic guiding principle is," he writes. "Seriously, I don't." He compares that to No Child Left Behind, a Republican bill on a traditionally Democratic topic that had its problems, but at least "insist[ed] on the vaguely conservative principle of accountability."

You could make a much better case for the conservatism of the Affordable Care Act than the conservatism of No Child Left Behind. The ACA insists on competitive, private insurance markets as the building block of a better health-care system. It begins to end the tax break for employer-sponsored insurance, a longtime conservative bete noire. It includes an individual mandate, which was once a conservative idea that promoted individual responsibility. But though Democrats have largely adopted these conservative ideas, conservatives have not declared victory and gotten to work on implementation. Instead, they've abandoned the ideas. But as Ruffini's post implies, that's left them intellectually adrift.

Perhaps it takes someone very familiar with liberal health-care reform ideas to say this, but this is not a liberal bill. Liberals believe access to medical care is a public good that should be provided by the public sector. The sop to that approach was the public option, which isn't even in the final law. That's why every time someone terms this socialism, I fantasize about Karl Marx, or maybe William Beveridge, stepping out Marshall McLuhan-style and saying, "You know nothing of my work!"

This bill is Clintonian: It achieves liberal ends through market means, and since conservatives frequently claim they are also in favor of access to medical care, it's not even clear that near-universal coverage can properly be called a liberal end. Not to mention that it's more conservative than the Great Triangulator himself was: It doesn't resemble his reforms so much as the Republican alternative to his reforms. But Democrats haven't gotten credit for that, in part because the opposition of Republicans meant they had to keep their liberals onboard, and that cut against trumpeting the conservative structure of the legislation.

But if President Mitt Romney had proposed this bill, a substantial number among his party would have stood with him on it, and no one would have trouble identifying what was conservative within it. And, to be fair, many Democrats would have fought the legislation every step of the way.

There's a lot of talk about the Republican failure on health-care reform lately, so let's just be clear about what that failure was. They didn't stop the bill. But they are in a far better electoral position than they'd be in if they had praised Obama for doing a great job reaching across the aisle and let him exchange modifications to the legislation for 30 Republican votes. In that world, their base is depressed and angry and Obama looks like one of the greatest presidents of our age. In this world, of course, their base is, well, fired up and ready to go, and Democrats have spent a year fighting with one another and almost destroying Obama's first term. Their political strategy largely worked, even if they didn't have the votes at the end of the day. As for their policy strategy? I don't think there ever was one.

Well, also to be fair, a lot of progressives did fight this bill every step of the way. You say correctly, that this bill is not particularly liberal except in its goals, which are only liberal in that conservatives are willing to abandon them so readily. Liberal opposition to this bill and the process that started it goes at least as far back as single payer advocates being arrested in Max Baucus's committee hearings for disrupting the proceedings.

While I'm glad the bill passed, it's just this thankless conservatism which makes me still feel the bill was a political failure, when measured against its potential. It is a bill without a constituency. Too conservative for the liberals, and too proposed-by-the-Democrats for the conservatives. I'm sure the Democrats will gain the benefit of a success politically, but they could have gotten so much more (and with better policy outcomes at the same time).

Oh well. No one ever accused the Democrats of being steadfast to their ideals.

I suspect the GOP's political advantage will ebb somewhat by November, too, as the American public slowly learns what the law entails. The fact that 25-year-olds can remain on their parents' plan while they search high and low for jobs will benefit a bajillion American families, and that benefit will be felt immediately, enough to win back some independents frustrated with the agonizing process and annoyed at the Democrats' weakness in the face of GOP obstructionism.

Which is all to say that the bill achieves liberal goals (coverage, not having people die because they work the wrong job), with conservative means (meaning it will be far more expensive than what is ideal, because in order to get anything liberal done we have to give our pound of flesh to the corporations who control our congress.)

Can we negotiate on part D? No. Pound of flesh.

Can we get cheapest possible insurance provider to do the admin work necessary? No. Pound of flesh for ins companies.

That's not to say this isn't a major victory. It really is!

IT is to say that I wish the anti-tax brigade would (see the value of, and) focus on making our programs more cost-effective once they lose. But, they don't. They would never line up with us to get better prices on Rx drugs via part D. And, there is no good reason in the world, other than maybe to urk people with common sense.

Instead, they say 'what's wrong with profits?' Well, nothing. But, it is YOUR (FUTURE) TAX DOLLARS. What other organization would buy on such scale without getting a discount?

The left should come out opposed to the idea, trick the tea-baggers, then say 'you are right!' Then, we'd have a strong grassroots effort. (And, they are clearly easy to trick.)

Why on earth would someone with Grover Norquist's stated goals oppose the gov getting better prices on something it spends so much money on? Well, because he's playing an inside game -- as we say with the Abramof scandal. (McCain had him there, and let him go.)

"But if President Mitt Romney had proposed this bill, a substantial number among his party would have stood with him on it, and no one would have trouble identifying what was conservative within it. And, to be fair, many Democrats would have fought the legislation every step of the way."

That is exactly right. And why is that? It's because the Democrats would have seen an opportunity to regain control or (if they already had it) expand it significantly in the next election cycle by obstructing the Republicans. They may have been better about it in some ways, but they would have done essentially the same thing--picked winning the next election cycle over real reform they could live with. There is no incentive to compromise on reform for either side, when the next election cycle is never more than 16 months away.

And that's because, in congress, elections are held every two years. I understand the principal, and understand that it's never going to change, but I think that's poisonous in the modern process. It effects the Senate as well, even though they have longer election cycles, because what happens in the house effects what happens in the senate, and their future political careers, the likelihood of their party carrying the Whitehouse, etc. There is no incentive to compromise or try to achieve policy goals because you're always "so close" to reclaiming or expanding your power.

That's what has driven the Republicans (and conservative punditry) over the past year: they can see the finish line, as clear as a bell, and all they have to do is frustrate and obstruct and mischaracterize the Democrats at every point. It's a powerful incentive, and, in the end, neither party is able to resist it.

The only solution would be to stretch out the terms they serve in the house. I think, at a minimum, house seats should be for four years, elections staggered. There are multiple reasons to do this, not the least of which is creating a period where half the members don't have to worry about the next election for 3 years. Ideally, it would be 6 years, just like the Senate. But I don't think it's going to change, so we will continue to have politics, rather than policy, dominate.

@burn: "While I'm glad the bill passed, it's just this thankless conservatism which makes me still feel the bill was a political failure, when measured against its potential"

Sheesh. You oughta be grateful. At least you got something. I had a Republican majority for 6 years and a Republican president for 8. And all I got was a lousy unfunded pre-emptive war. ;)

What I wanted was Social Security Reform. And Bush, to be fair, was on board, but the rest of the Republicans weren't. Cuz they saw the finish line, and it looked like they'd be more likely to cross it if they didn't have the burden of SS reform to carry. Goofballs.

Most conservatives don't think they got a single, signature piece of legislation--even a watered-down one--out of 8 years of Bush and 6 years in the majority.

We often labor on the news angle of who did what and even sometime, why, but that only exercises review of causes and symptoms. Our government needs a new framework and more bilateral efforts toward solutions, the most important leg in the cause, symptom and solution triangle.

There is far too much politics involved in the daily workings of Congress. Politics should be limited to oratory on the floor, as in the word, grandstanding, and during, say, two months before elections.

The thought that we will not cooperate because it might make the President look good is about as disgusting an idea as peeing in public.

I think conservatives would argue that the financing in the reform bill is too progressive. Furthermore, the regulation of the exchanges - guarantee issue, community rating, risk adjustment, rate review - may be a bit on the restrictive side (to which I'd respond: that's the only way this will work). Nonetheless, the core ideas about coverage are definitely ideas that conservatives should be able to live with.

@scarlota: "I suspect the GOP's political advantage will ebb somewhat by November, too, as the American public slowly learns what the law entails."

That's a very optimistic view of the American people. ;)

I would still argue that, given the (manufactured) controversy and the history of midterm elections, it's the Republican's election to lose. Which they may, but not because of their obstruction or hyperbole, but because they aren't offering a coherent platform, concrete policy proposals, or otherwise nationalizing the election, ala the Contract With America, the source of their 1994 sweep. Being the party of no (or, "not just no but hell no") is fine before the campaign cycle, but once the campaign starts, they have to start saying what they are going to do and, for a national sweep, that have to be on message. Which does not seem likely, at this point.

Kevin - I can see your and Ezra's point about how Dems would have obstructed, but do you really think every single Dem would have voted against a bill that provided insurance to 32 million people? I don't.

The Dems have NEVER been unified, they've never walked in lockstep, they lack the party unity. Will Turner, in 1935, famously said, "I'm not a member of an organized political party, I'm a Democrat."

Scarlotta, I was talking with a conservative friend yesterday who is convinced that there's a tidal wave of impassioned people out there ready to slaughter the Dems in the election. I don't doubt the Dems will lose seats in November, but I think conservatives are underestimating how hard it's going to be to maintain the level of intensity they've got now. I also think Dems will become more energized when they look back at the first two years.

Um, given that the entire liberal blogosphere has spent the last two days emphasizing and re-emphasizing how conservative this law is, perhaps the better question is, "What do liberals believe about health care?"

"The ACA insists on competitive, private insurance markets as the building block of a better health-care system"

1. That's a bad approach, the providers are the ones making the costs high. The consumer of health care must be the customer, if we want to drive value.

2. It doesn't really do that, because the restriction on pre-existing conditions means that you have to sell discounted, prepaid, health care to people not insurance. There needs to a price differential to go with guaranteed issue to prevent adverse selection. The penalty is too low to make this work, once people are educated on the microeconomics of it. The restrictions on the level of the various plans in the exchanges prevents the better solutions, such as HSAs and high deductible care, from being offered.

Kevin, as always I pretty much agree with everything you have to say on politics, though I think we do part ways on policy.

Still, I'm not sure that changing the election cycles for Reps would really lead to individuals breaking ranks, or at least not much. It's also just about impossible to get such a change passed.

The source of a party's lockstep behavior comes straight from the party's ability to fund the elections of their members. If we could cut the connection between party unity and money for elections, or just reduce the amount of money used in elections, I think you'd find a lot more independence in the ranks.

"Kevin - I can see your and Ezra's point about how Dems would have obstructed, but do you really think every single Dem would have voted against a bill that provided insurance to 32 million people? I don't."

Probably not, but the point still remains--most of them would have seen an opportunity to be back in power, and thus "do some real good" if they voted against it. It wouldn't have been health insurance denied, just health insurance delayed.

They would have also focused on the glass being half-empty. No public option? Outrageous! A giant giveaway to Big Insurance? Unacceptable. There would have been good argument to make that the cost was too high, even to insure 32 million people.

Some Democrats probably would have ended up voting for it, because I doubt their voters would punish them for voting for a moderate Republican HCR bill the way the base would have punished any Republican who voted for it. In many case, the Republican's lockstep unity came from listening to their constituents (who were being egged on by talk radio, etc).

@mosben: "I was talking with a conservative friend yesterday who is convinced that there's a tidal wave of impassioned people out there ready to slaughter the Dems in the election"

This could be true, but I still think a lack of a coherent campaign, concrete policies, something positive to nationalize the election on . . . without something more than "and we tried to defeat HCR", the tidal wave will fall short. I think having a coherent, policy-based campaign (ala Contract with America) that nationalizes the contest could mean +20 seats in the house and +5 seats in the senate over what they might win just based on the hyper-motivated base.

"The source of a party's lockstep behavior comes straight from the party's ability to fund the elections of their members. If we could cut the connection between party unity and money for elections, or just reduce the amount of money used in elections, I think you'd find a lot more independence in the ranks"

You may be right, although I think the party leadership could still make a compelling argument, every time: "Look, elections are in November. That's 8 months away! If you don't do everything you can do to stop the Lollipops and Rainbows Act of 2020, the base will know, and you will be toast. But your campaign is publicly financed, so do what you want."

And, yes, I know terms are never going to be extended for house members. It would require a constitutional amendment that specifically contradicted what's been spelled out in the constitution. That would never, ever fly, and I know that. I'm just saying, I think a big chunk of the structural problem is the 2-year terms of house members.

Tom Price (R) of Georgia's 6th district, has for months had a well-written bill in HR 3400 that lays out a Conservative Version of Health Care Reform. It is a good bill, much shorter and much closer to budget neutrality and coverage effectiveness than the monstrosity just passed. It has never seen much media coverage.

Why? Perhap the progressive media can't make it fit with the "Party of No" portrayal that they wish to construct. It fits much better to declare that everyone has the choice of ObamaCare (D), or Nothing (R). An effective cliche tactic: Impale your opposition on the horns of a false dilemma.

Now this article, "What do conservatives believe about health care?" is a beauty: (1) We spoke to a single conservative. (2) He didn't have a plan on healthcare. (3) Therefore, conservatives aren't really concerned about health care.

Non-sequitur: it does not follow!

I think it is well-documented that Republicans give more to charity - both in terms of absolute amount and percentage - than do Democrats. Conservatives realize the difference between helping someone, and voting to compel others to "help".

What do conservatives believe about health care?
Conservatives says that alligators are ornery because they got all them teeth and no toothbrush. ~Mama Boucher
So that's what opening up a can of whoop-ass feels like.
Dems., you just opened up a whole case of whoop-ass.

MKS1: "Tom Price (R) of Georgia's 6th district, has for months had a well-written bill in HR 3400 that lays out a Conservative Version of Health Care Reform."

Then he should give Ezra a ringy-dingy. I bet Ezra would have covered it. In fact, I'm sure a lot of people would have covered it (with a spin that it was dissension in the Republican ranks). It's not good enough just to write a bill, you have to advance it. And understand that there will be obstacles. You don't just write a good bill and have everyone automagically understand how awesome it is and then it just becomes law.

"I think it is well-documented that Republicans give more to charity - both in terms of absolute amount and percentage - than do Democrats."

The Democrats give a lot more of other people's money away. And, frankly, you just can't trust people to make the right sort of choices when picking a charity. They might give it to a church. Much better that the government take your money, then donate it for you.

Plus, you don't have to give any of your own money to charity if you vote for people who want to raise taxes and increase entitlements. It's like buying carbon offsets: you're morally liberated from having to practice what you preach.

@KW: but they would have done essentially the same thing--picked winning the next election cycle over real reform they could live with. There is no incentive to compromise on reform for either side, when the next election cycle is never more than 16 months away.

Expanding on nisleib's post, no matter who is in power, there are plenty of blue dog dems desperate to prove their "conservative" credentials and vote with the repugs. The number of republicans that want to show their "liberal" or even centrist credentials can be counted on the fingers of 1 hand. This reflects the heterogeneity of the dems, with room for both conservative and progressive members (for better or worse), while the repugs have no use for anyone left of Franco or Mussolini. They have almost completed their pogrom on moderates in the house and the Maine twins are the only moderates left in the senate and they showed their moderation by voting with the rest of the party of no on HCR.

So, at least the conservadems in both the house and senate would be happy to sign on to a republican bill if it threw some scraps their way. Repugs, OTOH, are so reactively anti-dem, that they can't even vote for policies that they came up with when a dem proposes them. See AEI 2003 healthcare proposal, the Baker, Dole, Daschle plan, or the 1993 repub response to hillarycare for examples of ideas that are in HCR now.

This is why the repubs are becoming more and more a regional party of the former confederacy with some outliers in the mountain west. Again, the number of repubs in the North east, once a bastion of republican orthodoxy is now solidly dem. Ideological purity has its advantages in messaging, but it is not a winning electoral strategy. I think that dems will lose some seats in congress, but that is mostly because it won almost every competitive swing seat in the last 2 cycles and so the dems have to defend many McCain leaning districts along with the historical trend of the President's party losing seats in midterms.

@KW: Republican's lockstep unity came from listening to their constituents (who were being egged on by talk radio, etc).

I don't believe this. I think repugs were listening to their corporate donors, more than their constituents. The rightwingnut echo chamber distorted the elements of the bill so egregiously that most people don't know about the benefits. So I think the agency is wrong in your post. Repub pols and the rightwingnut echo chamber drove public opinion, it did not reflect it. If HCR were laid out in a semi-truthful fashion, it would have majority support in all but the most heavily conservative districts.

I think Ezra's being a little too kind to the GOP's political strategy here. Yes, they'd be in deep doo-doo with their base if they'd negotiated instead of stonewalling. But they're in pretty deep doo-doo with everyone now. They've just shown themselves to be utterly impotent and incompetent, and they're up against a strong, popular president who already, in his second year, has an historic piece of legislation under his belt. To independents, they look crazy. To their base, they look useless and small while the hated president looks commanding and has already sealed his place in the history books -- even Texas's.

Translation: beyond a nibble on the outer margins, it does not end the tax break.

The result is that everyone who gets employer-based health insurance receives subsidized health insurance. The ironically named Affordable Care Act extends insurance subsidies in exchanges to people with incomes up to 4 times the poverty level. As a result, the vast majority of people will have subsidized health insurance. You know what happens when you subsidize something, right?

I think it is well-documented that Republicans give more to charity - both in terms of absolute amount and percentage - than do Democrats.

I think if you categorize the charities as secular and religious, dems probably give more to secular charities than repugs with the reverse true for religious charities.

To Kevin's bigger point, I just don't believe that we as a society should depend on the kindness of strangers to fund the social safety net that is clearly necessary in our incredibly economically stratified, society. For one, depending on religious charities to feed the hungry, cloth the poor, etc. subjects them to religious dogma, which I think is wrong. Charities also have the option of not serving anyone they don't like so gays, transsexuals, etc. might not be welcome or might not FEEL welcome getting charity from the catholic church which considers their behavior an abomination. As the richest nation on the planet, we have a responsibility to provide a basic standard of services to those that have been marginalized by our economic and political system. Depending on charity abdicates that responsibility often with tragic results.

@srw3: "Expanding on nisleib's post, no matter who is in power, there are plenty of blue dog dems desperate to prove their 'conservative' credentials and vote with the repugs."

That repugs thing never gets old. No, wait, it does. ;)

That being said, I don't think there's a lot of tolerance for divergence from liberal orthodoxy in the Democratic party, either, they just aren't as far along in getting rid of their heretics, yet. The next election cycle will see some of the blue dogs saying goodbye, and it won't be long until both sides enjoy similar party unity.

"Ideological purity has its advantages in messaging, but it is not a winning electoral strategy. "

It don't think it's necessarily a losing one, either. The Democrats have been on a long march towards greater ideological purity, as has the Republican party. During this time, both have won elections, and not necessarily on the number of dissenting voices or RINOs/DINOs in the pack.

If the Democrats continue to rid themselves of the blue dogs, then both parties will be ideologically pure, and thus fighting each other on an even footing.

In any case, Frum may think the Republican's failed on healthcare, but I don't know. They almost stopped the bill, and the bill we ended up with was a lot more conservative than it was liberal. And that happened, in both cases, because the Republicans were fighting, tooth and nail, no holds barred. I think, right now, the Republican strategy is working. Time will tell, I suppose.

Kevin says, "I don't think there's a lot of tolerance for divergence from liberal orthodoxy in the Democratic party, either, they just aren't as far along in getting rid of their heretics, yet."

Nope, sorry, you couldn't be less correct. This is why I've never been a Democrat even though I tend to vote for Democrats. Look at the history involved, the Democratic party has been around for a very long time and they've never shown the unity the Republicans show. Ever.

I know it is easy to say both parties are the same, but they aren't.

I wish the Democrats had the cohesion of the GOP, but they don't. If they did we probably would have had universal health care 50 years ago.

Heck, roughly half of the Democrats in the Senate voted FOR the Iraq war. When was the last time you remember Senate Republicans splitting their vote 50/50 on something as big as the vote to go to war in Iraq?

The Democrats have been on a long march towards greater ideological purity.

The DNC DSCC and DCCC put more of their support toward bluedog incumbents than toward "liberal" congresscritters every election cycle. Look at Blanche Lincoln, Mark Pryor, Ben Nelson, Mary Landrieu, etc. dem apostates, not to mention supporting holy joe over lamont in the primary. Was the dem establishment trying to be ideologically pure leftist by supporting holy joe? Obama and the DNC are working for them, not purging them. Same for bluedogs in the house. Beyond Scott Brown and the Maine twins, show me any similar republican support for the more "moderate" wing of the republican party (if there is one).

The dems still try to maintain a big tent for better or worse. There are groups like actblue that support more progressive candidates, but they are not the policy wing of the DNC.

@ KW: And that happened, in both cases, because the Republicans were fighting, tooth and nail, no holds barred.

No, Kevin, it was the conservadems fighting tooth and nail. By not participating in any meaningful way, the republicans completely marginalized themselves. But I agree, as a matter of policy, HCR looks more like a center right plan than a progressive plan. As a matter of politics, republicans lost big time.

I thought repugs was a kinder, gentler, expression than repiglicans (old favorite) or hypoclicans (new favorite). Some here feel that these are too derogatory so I am trying to clean up my postings. I also use dumbocrats on occasion, but the dumbocrats have never ran crying to mommy about that.

According to Klein, the bill fails Democrats because 1) it is compromised and abandons single-payer for a market-based approach and 2) because Obama failed to get bipartisan support despite any of these compromises. Meanwhile David Frum gets fired from AEI because he claims that the Republican failure was a failure to compromise and negotiate so that the bill could reflect conservative policy. If this seems contradictory, the problem lies in confusing the liberal/conservative split as a split along party lines. The goal of compromise was to get support from conservative Democrats, not from Republicans. The Republican policy was simply to oppose and not negotiate. So the conservative Democrats are now the conservatives that are willing to negotiate, and the Republicans are the conservatives who are not willing to negotiate. So were there any winners? The liberal Democrats, who got the bill passed, the conservative Democrats, who got the liberal Dems to compromise, the Republicans, who wouldn't budge, the millions of uninsured Americans who need health care, or all of the above? Or some of the above?

@srw3: "The DNC DSCC and DCCC put more of their support toward bluedog incumbents than toward 'liberal' congresscritters every election cycle. Look at Blanche Lincoln, Mark Pryor, Ben Nelson, Mary Landrieu, etc. dem apostates, not to mention supporting holy joe over lamont in the primary."

The GOP supported Arlen Specter over Pat Toomey (not unlike the DNC and Lamont and Leiberman), supported Jim Jeffords with plenty of cash (until he jumped), supported Lincoln Chafee until he became an independent--not because he wasn't getting the cash, but because he didn't like the rightward lurch the party overall was taking, in his opinion. The national GOP endorsed Dede Scozzafava over Doug Hoffman in New York, if you recall. Just a few months ago. That sort of stuff happens. It's not necessarily the national leadership (of either party) that's demanding ideological purity. Michael Steele has been ambivalent about the whole "ideological purity" thing, and may eventually find himself ejected.

Let me put it to you this way. Do you think there are going to be more or less bluedogs in congress after the elections in November? Even Bayh is gone, there have been multiple attempts to eject Leiberman, they just haven't worked, yet. I think Ben Nelson and Stupak may soon be electoral casualties. How conservative do you think the Democrat party was, overall, 20 years ago, compared to today?

I may be wrong, but I think the Democrats will be much more ideologically pure over the next few election cycles. Maybe not. At the same time, the Republicans current state of ideological purity may be temporary. Many, if not most, of the Republicans are ideologically pure as a political gambit. If it turns out not to work, they will become ideologically impure, if they think it will win them the next election. It wasn't so long ago that the party had Arlen Specter, Lindsey Graham (and we still have him), Lincoln Chafee and Jim Jeffords. Also, the pre-2008 "maverick" McCain. And assorted also-rans. The current ideological purity is new (how many other pieces of legislation can you think of where absolutely no Republicans voted for it?) . . . I don't know that it's going to last forever.

And to be clear, I don't know that the DNC is going to drop the big tent approach. The RNC really hasn't dropped it (it's just that mums the word). But other actors, including the voters, seem to be moving both parties (in my opinion) into further polarized, more ideologically pure states.

This is worse than you think for the Republicans. In the short term, they look bad for losing. In the medium term, they've stirred up the Tea Party nonsense which is going to hurt them with right-wing primary challenges and foolishness that turns off moderate independent voters.

They've also made the whole nation spend roughly 9 months talking about health care: an issue on which people have always trusted Democrats more than Republicans, and still do. If the next election is about health care, Democrats will win big again. Already the Republican talk of repeal is being summarized as "running against health care". That's a lousy message.

In the long term, the Republican party is in a demographic trap that is tightening rapidly: they don't get many votes from minorities, they don't get many votes from Gen-Y voters, and those groups are more and more of the electorate in each cycle. The ACA reforms are going to be good for young people (stay on parents' insurance to age 26; big subsidies for low-paid workers with McJob) and minorities. And every single Republican opposed those reforms: that's going to kill them in the future.

Their only chance is to pull out a narrow
takeover of the House in a low-turnout midterm election by energizing their base. But I don't think that's going to work now that Dems have a big achievement to boost enthusiasm and fundraising.

@KW:It wasn't so long ago that the party had Arlen Specter, Lindsey Graham (and we still have him), Lincoln Chafee and Jim Jeffords. Also, the pre-2008 "maverick" McCain.

First Linsey Graham is no moderate:

"Graham voted the conservative position 88 percent of the time in 2009 and has a lifetime conservative rating from ACU of 90 percent. " In fact he is ranked 25th most conservative in the senate so there are 15 senators more moderate than him (although there is a big cluster around this ranking). Did he break ranks once during the health care debate or the stimulus debate? Didn't he support filibusters repeatedly? While he talks a semi-moderate game during bargaining, has he actually voted for any moderate or progressive bills?

On McCain you have to judge by where he is now and over the last year. He didn't even support legislation that he previously sponsored and supported once dems came out for them. How is that for moderate? Climate change, DADT, immigration...Is he moderate on any of these issues. Did he break ranks once during the health care debate, the stimulus debate, or anything else in the past year? Didn't he support filibusters repeatedly, even though he castigated them when he was in the (much smaller) majority?

Well where are they now? Out of office or out of the party. Lincoln, Nelson, Pryor, Webb, Hagan, and Bayh (although he is retiring)and others are all still in the dem party.

I think that the rightwingnut tendency of the party made Jeffords and Chaffee and Specter (although he is a rank opportunist) leave the republicans. Isn't that ideological purity at work?

The dem party is more diverse and will remain more diverse (for better or worse) than the republicans. Specter was driven out by a challenge from the right, correct?

"Do you think there are going to be more or less bluedogs in congress after the elections in November?"

This is a silly question. There will be fewer blue dogs because the repigges got beat so bad in the last two election cycles that the dems are defending lots of red leaning districts, so they are bound to lose some of these eventually (the nature of swing districts is that they swing) and historical trends point to dem losses. I think I put this in my last post, with no refutation of these basic points from you.

NICE SPINNING nothing out of nothing...where did you find this alleged conservative strategist???? in the Majority office, no doubt.

The Conservative think tank in Maine; as are many of the hundreds of others around the world, is led by Tarren Bragdon(R) a 'wunderkindt' first elected as the youngest legislator in Maine history, and now an expert on Health care because of his role in shaping and opposing Dem legislation.

Try calling him or any of the hundreds of experts in Heritage's expert directory who usually have PhD's or MD's and extensive experience in the field.

...what DID you do with your copy of the shopping list given to Obama by the R's?

Re: the comment of the day.
The writer sounds like an educated guy. However,"educated" suggests an ability to look beyond the end of one's nose.
Most of the benefits were front-loaded while most of the burdens are designed to kick in after the next presidential election.
Meanwhile, they are going to have 30 million new people into the system but have done nothing to increase the capacity of that system to handle this influx. Most of those new people will be under a government-controlled program that already underpays providers by an average of 20%. That will reduce the number of new providers coming into the system and exacerbate the problem even further.
Then throw in that the finances holding this up are essentially the same methods used by Bernie Madoff and Enron, and you have an economic disaster.
The quality of care will decline, the waits for care will increase.
Finally, when was the last time anyone remembers a government-run program that did not exceed by a huge margin its cost projections?
This is a bankrupt scheme, conceived in an ideological quest for political power and made possible by disgraceful and blatant political payoffs.
The stench of this will be here for a long time.

Why apply labels like "liberal" and"conservative" to the health care debate? Any attempt to analyse or reform health care needs to deal with 3 issues: coverage, cost, quality. The bill that has now become law extends coverage to 31-32 million Americans and claims to reduce costs by over $100 billion over 10 years. The impacts on quality remain to be seen. I support this plan because at least two or out three is better than nothing. I would support it no matter what party proposed it.

Ezra, Ezra, Ezra...
You think that this is a conservative bill? Then you are missing the point of the bill, and what conservatives actually stand for.
This bill is the vast expansion of big government. It creates something over 1,000 departments, commissions and committees. The bill calls for something like 1,600 IRS agents to be hired to make sure the people follow the plan. It puts new tighter restrictions on "those greedy" insurance companies that will severely cripple them or put them out of business. That is how this bill will lead to the "single payer' system that the progressives so dearly crave. It is not in the bill, but the bill is leading to that result. And they said the public option would create competition; it will more likely desrtroy it.
Now, as to what conservatives want. We want smaller government. We want the government to get out of our way as we pursue our daily lives. Our forefathers left their homelands and came to America to escape the oppression of an overbearing government and to realize the freedom that lets them prosper and grow. This government is trying to take away that freedom and and individuality and replace it with a dependance on the government. This is what conservatives do not want.
The conservative approach to health care reform was simple: allow insurance companies to sell policies across state lines (real competition), ensure that people with pre-existing comditions are covered, and implement serious tort reform. These will all lower costs to the people without government overreaching into the public sector.
By letting insurance companies sell policies accross state lines, costs would go down because the companies would be able to sell the policies the consumers want, rather that what the government requires.
If insurers were rerquired to allow pre-existing conditions, the patients' treatment would be covered by insurance and not the free care funds at the hospitals. This, in turn would lower the providers' need for such funds and reduce their costs and fees.
Finally, if serious tort reform was enacted, medical providers would be less subject to spurious claims that serve to drive up malpractice insurance costs and make lawyers rich. Doctors would be able to treat their patients for the problem at hand, and not have to provide "defensive medicine" which adds to the costs.
This is the outline of the conservative approach to health care reform, not creating a situation where the government takes over the industry.

I do have a problem with my fellow strict constitutionalists and conservatives. They have failed to hammer home HOW Congress intends to pay for our $100 trillion in National Debt and unfunded liabilities for Medicare, Social Security and Veterans Benefits. Hellow Value Added Tax and Cap & Trade Tax (ENERGY TAX ONLY 20% OF WHICH WILL GO TO GREEN ENERGY). Needless to say Obama will sign these bills in a heart beat.

Why have you not pointed out that these taxes will be the final great Lie in Obama's campaign and time in office. No taxes on anyone making less the $250,000, less than $200,000, less than $150,000, less than $88,000, and now spending ANYTHING over $0.00!!

You simpleton. Your words point in every direction but the truth and you think the voters won't see it.

Conservatives, like myself, believe there are 3 almost certain outcomes from the health care reform bill and other Obama policies:

1.The federal bureaucracy will grow and, as more power shifts to Washington DC, it will stifle business innovation and bring about economic stagnation and increased public corruption
2.The federal deficit will reach 100% of GDP and inflation will become rampant
3.Jobs in the private sector will remain in decline while taxes and government grows

The argument is/was not about health care, conservatives presented bills that would address health care costs without requiring a massive growth of government entitlements and our national debt. The argument has been about politics, money and power. Instead of everyone wanting a piece of the pie liberals believe that we are all entitled to a piece of the pie. What's has been pushed aside is the economic cost of this and the loss of individual freedoms.

Our federal government now borrows 42 cents of every dollar spent and our answer is more government spending! Our liberal politicians question if health care costs are sustainable. Conservatives know that current federal spending is not.

If we are to survive, we must have an economic policy that grows business and jobs in the private sector, not a populist policy that grows federal spending.

Perhaps conservatives (Republicans) would not have opposed this bill so fiercely if it were to be financed by a newly implemented Value Added Tax rather than taxes on high value insurance plans and high earning individuals and families. It has been said that the U.S. alone among induatrialized nations does not have a VAT is because conservatives see it as amoney machine for government and progressives see it as regressive. Perhaps if those viewpoints were reversed, the U.S. would have a VAT.

What Mr. Klein doesn't seem to understand is the majority of Americans oppossed this particular Health Care bill because of how it has been crafted...The majority who oppose this bill are Republicans, Democrats, and Independents...I'm not sure who Mr. Klein's sources are but it isn't just the conservative's who are sorely disillusioned with our legislators as well as President Obama and his administration. I'm a health care professional and its truly shameful how this bill was crafted and passed...All of these backdoor deals such as the Louisiana Purchase, Rahm's juvenile scare tactics which he used to bully politicians to vote a certain way, and these legislators voted for a bill which they have absolutely no idea what is in it. That is deplorable...

Speaking as a Conservative, what is truly SCary is to Hear Dinged Dingel speech about " retraining the Public".... the self proclaimed head of the Judiciary whose wife is in JAIL ( Conyers) inventing New Constitutional amendments like the " Right to feel godd and mnay others" ... and Cong WIEINER of NY who Screamed 5 Times on TV that the Obama Health Care m,akes no Provision for 16,500 more IRS Employees in BROEN SHIRTS to Spy on the American People.... and CBO given the wtong Numbers to calculate ( see SS) is giving out FALSE and FRAUDULENT FIGURES>..Does nayone in DC have any CLUE at what they are DOING?????

The GOP "Plan" was simply to obstruct, to marginalize, to deny, to prevent forward motion on the bill. By blocking any forward progress, they could take their message to the voters that the Democrats were unable to govern, and should be replaced. What was amazing was the lengths to which they would go to accomplish their goals, "Death Panels" as a prime example. The upcoming elections should be most interesting, putting Lincoln's old maxim to the test once again. Where oh where is the GOP of 15 years ago? Certainly not within the Tea Bag Party. For what has become the Republican Party; the Party of NO!, the ends justifies the means, at any cost, to the people, or the Country.

No need to be confused by what Repubs want in Health care legislation, or for that matter suggest that Repubs themselves don't know what they want. Conservatives wanted a market based system-that didn't bust the budget or for that matter deplete by $500 billion apiece Medicare and Medicaid. On this basis alone its disingenuous to suggest that Repubs would have supported this tortured law if it had been sponsored by Romney. Its also fair to say Repubs would have insisted on a more intelligently crafted bill. This turkey actually encourages spurning the purchase of insurance until one contracts a costly medical condition. Given the bill's provision that no one will be turned down for coverage because of a pre-existing condition look for millions to game the system for their benefit---while passing the cost, Democrat style, to someone else.

Here's a prediction: Now that the Taliban approach has failed, we're going to see a major charm offensive from the Republicans. And another prediction: The media, who are a p.r. arm of the Republican Party, will play a key role in spreading the love.

paulann1, i beg of you to read the cbo report or other unbiased source. if you can find anything about the irs agents, you would make news. because if that was actually in the bill -- and not on talk radio -- it'd be a huge political story!

the "see what's in it" quote is completely stupid. it meant that the President would have to sign the bill into law and praise it more so that Americans could more clearly see what was in it to like.

"fined" ... do you like getting "fined" in higher premiums every time an uninsured patient goes to the hospital? i sure don't.

Perhaps policy strategy wasn't foremost in Republican objections to Obamacare, There were fiscal considerations, opposition to government growth and quite frankly other priorities the right placed ahead of health reform. The Annie Hall bit is humorous and well played in Mr Klein's analysis. However, change subjects and someone from the right can just as easily question the President's policy strategy in processing war on terror. Begrudgingly Obama has been forced to admit it's war, but with enthusiasm for Iraqi withdrawal plans equal to, if not superior to processing war, one wonders where we stand on defeating forces aligned against us.

The left is trying to paint Republicans as cold hearted, penny pinching, pro insurance industry cads, in preparation for launching their do-good story before November elections. Good luck. I think it's easier to paint Democrats as sanctimonious know it all's, willing to once again create entitlement, demanding funds we don't have, during a period of severe economic crisis, setting up prospects for future tax increases, while fundamentally doing nothing to bend the curve that restrains health care expense growth.

Call me old fashioned, hard headed, un-fair, too much with tough love, or what ever. My twenty two year wants to remain on my insurance after they graduate college and move out from my roof - BULL! My parents didn't help me after I flew from the nest and no one helped them either. When my wife and I started having children I didn't see the state passing around a spare tit then and we didn't ask for one, either. Now days, people in this country are too lazy to do for themselves and want the government to do everything for them. I still remember another great president who said, "Ask not, what your country can do for you. Ask what you can do for your country." The Democrat party is nothing like what it was then - that is why I dropped my party membership a long time ago. And no, I'm not a Republican! I believe in common sense politics - something that died shortlyafter JFK did. How many of you running around applauding the passage of the health care bill even know that the CBO claimed in a report that retired and disabled vets were a large cause of the problem within our health care system? Oops! No one! Doesn't surprise me. Mr. Obama said we are all going to have pay something. He wasn't kidding! As a retired vet from the Air Force and also a disabled vet (rated 100% disabled in line of duty) I will lose between 22 & 23 percent of my health care benefits. That was in the CBO's report to Congress. The CBO had already obtained legislation to do this when they presented their report to Congress! Where is legallity in this? Now, to make matters worse, between now and the next presidential election, ALL RETIRED MILITARY VETS will lose the remaining health benefits they were promised when they took their oath. These benifits were passed and signed into law by a Democrat controlled Congress and president years ago. The Dem giveth, and the Dem taketh! All with the stroke of a pen. But what heck, The Democrats have been taking away the benefits of G.I.'s since the Carter Adminstration. Don't take my word for it, check it out yourselves - I did. It's all a matter of public record. Why are they taking away military retired and disabled vet health benefits? Where do you think Congress is getting the funding for this "Historical Health Bill."

Well, everybody here is so happy. Look we are all covered. Well, not children that are sick, oops didn't read the bill missed that. Canada, England and even France are burden from there Socialists costs and are now looking to step away from government control of their lives. Oh wait, Greece out of money, but no problem oops again Protests in the streets. Remember what Margaret Thachter said, The only real problem with socialism is, that you eventually run out of other people's money."
Honestly, before you all get too giddy, READ the bill. Read the reconciliation bill. And get ready for the VAlue Added TAx to pay for all this.

Wait, it isn't free? Only the rich will pay. Guess what.....since this bill is not indexed before the 10 years are up that "rich" factor drops lower and lower. But, he we are all covered until they realize we can't pay for it so the next best thing...Ration Care.Do less won't cost. Are you really "worth" that hip replacement? Don't believe me look across the pond at England. Vision of Christmas future. You young visionaries re-read the book 1984!

Problems exist in our healthcare system, but to fix a bad roof you don't tear down the house! 31 million new patients....WOW....no new practitioners to serve. Oh yea, the Emergency Rooms won't be busy. Well.......try to get your MD after 5:00. They aren't getting paid so the message on the tape will say....go to the E.R.
This is change we can believe in. By the way, the congressional leaders who wrote this bill, exempted themselves from the bill. So, finally I ask, if they won't eat their own cooking, why should we?

Why do we have to talk about liberals, progressives and the other words that politicians use to describe each other.

This is bill is a pig in a poke.. and the pig may have a little lipstick on it but it is still a pig in a poke.

No my good only daddy was a hard line democrat, and I WAS a democrat until the party put OBAMA into position to become our POTUS.

I am college, educated, former Infantry Office during Vietnam and have been in middle to upper management all my life.

So I have been over the creek a couple of times.

I am willing to bet an old silver dollar that no one on here has read and understands this Pig In a Poke. The author is just another OBAMA LACKY. I am trying to read the damn thing... BUT I am not a lawyer.

I seriously doubt if there is anyone in the White House.. BO included that has read and understands the ENTIRE DOCUMENT.

There is definitely no one in the House or the Senate that has read and understands the entire 2700 Plus pages of this "pig in a poke".

As individuals read and understand sections of this IT IS A GREAT thing for America.

Bull Cr-p. What is great for America is to VOTE EVERYONE out on the hill that has been in office for more than three terms. Everyone on both sides of the aisle. The dems must lose control of both the House and the Senate in 2010. Once this is accomplished then in January 2011 the people can demand IMPEACHMENT of Obama for HIGH CRIMES AND TREASON AGAINST THE CONSTITUTION and the people of the United States.

Those kicked out of office MUST have their pensions cut in half, and placed on the doles of this OBAMACARE

The true war in America will not be over HealthCare but over Religious Freedom. Americans have always known that Communists sent their citizens to Jail, but now the Marxists in Washington are seeking the same thing. Therefore our Forefathers have authorized us to PEACEFULLY fight back through our Religious Freedoms. The proof that these Freedoms work today can be seen in looking at the native Americans who are legally allowed to hunt whales, catch salmon in nets, and even laughably still use hallucinogenic peyote, all in the name of culture and Religion.

So does a Judeo-Christian culture offer similar Unalienable Freedoms? Well, besides Native Americans, Anthropologists have just discovered a new people called the Amish. In studying them it was concluded that these individuals are actually American citizens!! Based on this amazing research lawyers have become resigned to the fact that the Amish have a right to exist as a Free People. They CHOSE a life outside of Big Government and have been allowed a RELIGIOUS EXEMPTION to Obamacare. No Jail or IRS harassment. Amazing . . . having an Unalienable Right to place your body under the providence of God . . . all because of a Religious Belief. No Paperwork, no forms to fill out. Sign me up!! Millions of people will easily repudiate the Media and our Marxists leaders as Obamacare moves towards enforcement. Washington is ready to roll it's tanks into Tiananmen Square, but the Tea Party will win.

Republicans din't fail! Obama and his comrades FAILED to listen to the American people and LOST the confidence of Americans.

Republicans have now the trust of the American people.

The stench of the lies, manipulation, intimidation, coercion, bribery, corruption, and backroom deals to force us to swallow the Obamacare SCAM -- which would destroy our health care, our economy, our freedoms and our country -- has forever tainted the Democratic Party.

More and more Americans understand there's no longer a Democratic Party. The Democratic Party has been replaced by the Progressive (Marxist) party, controlled by U.S. enemies like George Soros and bent on destroying America using the tactics of their mentor Saul Alinsky.

We would be safer voting for the mafia than voting for Democrats. Republicans will get my votes for the rest of my life. Republicans are not perfect, but they are not U.S. hating Marxists bent on destroying our country

You are right, givenallthings. Regarding the IRS agents, the gall of dictator Obama surpasses that of Castro or Chavez.

After Obama's comrades are known for cheating and NOT paying taxes, Obama will force us to pay additional taxes and will spend our hard-earned money to hire 16,500 additional IRS agents to steal as much as possible from us and punish us if we don't! Try defending yourself from thousands of IRS ACORN-type agents!

Thank you for your insults, dear Obama's operatives or lemmings! Coming from Obama’s ACORN operatives or lemmings, any insults are welcome and further demonstrate that Obamacare is part of the Orwellian future that Soviet defector Yuri Bezmenov warned us about: http://www.dailymotion.com/video/k6KUDv1wzraWhwlBt1

The dumbed down are obviously unable to understand how they are contributing to “the American descent into Marxism,” which “is happening with breath taking speed, against the back drop of a passive, hapless sheeple…” http://english.pravda.ru/opinion/columnists/107459-american_capitalism-0

Fortunately, as we can see now, most Americans have not been dumbed down and they will do whatever necessary to defend themselves, their children and grandchildren from the abomination of Obamacare and Obama’s plans to transform the U.S. into another failed socialist country like Cuba or Venezuela.

Ezra Klein is one of those liberal news journalists to whom TRUTH has no relevance. Winning is everything. No fact that can't be twisted, no number that can't be falsified, no words that can't be quoted out of context, no event that can't be spun ... if it promotes "the cause".

I think Ezra gives a fair summary of the bill. What I would disagree with is that he ignores the extent to which it initiates a process of reform. Social Security today bears little resemblance to the Social Security Act passed in 1935. It has been expanded, most of all in the 1960's, and trimmed in the 1980's. Similarly the government has begun to take responsibility for providing health care or health insurance to the great majority of the American population. That's the achievement, and is worth celebrating, even if the first steps are modest ones.

Wrong, johnnormansp! Those of us familiar with U.S. hating Marxists and Marxist scams like Obamacare did not need Palin or Joe the Plumber to undertand that Obama is a U.S. hating Marxist and Obamacare is a Marxist scam.

When Obama was running for President, those of us familiar with Castro, Chavez, and the rest of the Marxist thugs who are destroying Latin America recognized Obama’s kinship with them.

Obama’s campaign strategy -- based on lies, manipulation, intimidation and fraud, with overwhelming support from a corrupt media -- was almost identical to the strategies of the Marxist thugs. Even his slogans (CHANGE and YES CAN) were the same.

However, many of us believed Americans were too smart to be fooled as the most ignorant Venezuelans, Bolivians, Ecuadorians had been fooled. We were wrong. Americans were fooled…many had been dumbed down as per the warnings of Soviet defector Yuri Bezmenov http://www.dailymotion.com/video/k6KUDv1wzraWhwlBt1

Obama's strategy to get elected and after he became president is almost identical to that of the Marxist thugs in Latin America.

They also began with CRISIS, URGENT bills to solve URGENT PROBLEMS. They are "URGENT" to the would-be dictators because, when people realize what's happening, they try to defend themselves, as it happened in Honduras. By the way, Obama was siding with the Marxist thugs and trying to force democratic Honduras to submit to Castro, Chavez, Zelaya and Marxism!

But our situation may be already worse than that of Honduras. Honduras still had independent Legislative and Judicial branches that defended Hondurans from Zelaya. In the U.S., Obama largely controls the Legislative branch and, if he gets his way, will soon control the Judicial branch. Add to that the fact that he controls 80% of the media.

Fortunately, as we can now, most Americans are waking up. Most Americans are NOT sheeple! Most Americans are ready to defend their FREEDOM and the freedom of their children and grandchildren from the abomination of Obama's criminal scams and socialism/Marxism.

Very rushed with relatives visiting, but I think it's important to get this down, even if quickly:

Today's Republicans are so extreme, that their policy strategy, or preference (and they do have one), is pretty much laissez faire. It's make people even more on their own – get rid of the protective regulation that we do have, get rid of the government support we do have, like Medicare (which they fought tooth and nail and called socialism when it was being decided in 1965), Medicaid, SCHIP, etc.

Of course, they can't say this because it would be political suicide (as well as meaning that most of the population wouldn't have health insurance, and we would pay three times as much for equal or worse care than single payer countries) , so they just try to stop any further government protection and support.

AntonioSosa posts again about communism, socialism, Marxism - not even knowing the difference. What a joke! You have to actually know what these things are before posting or you'll make glaring erroneous comments or you'll end up mistakenly grouping together socialism and Marx or communism. YOU HAVE TO ACTUALLY KNOW WHAT ALL THESE THINGS MEAN IN ORDER TO COHERENTLY COMMENT ON THEM. Please stop embarrassing yourself.

Obamacare conservative? Too funny. You mean a new middle class entitlement, massive tax increases, hundreds of new federal agencies, thousands of new federal burecrats and massive new government spending are all conservative. I guess when you operate on the fringes of the left wing it seems conservative but not to a real conservative.

I just found out today that the new health care legislation provides for a substantial across-the-board reduction in what doctors get paid for treating patients on Medicare. That sounds rather ominous to me, but it will be interesting to see what effect or effects that reduction actually has. I believe that doctors are generally over-compensated over the long run, but most new doctors have taken on so much debt to get through medical training, and have endured so many grueling trials and tribulations during internship and residency, that there is an understandable sense of entitlement that most of them have as far as later wealth accumulation is concerned. Perhaps we need medical schools run by the government --- as our military academies are run today --- to train doctors at government expense in exchange for the students agreeing to serve in a United States Medicorps for some period of years after they become doctors, just as our academy graduates have to serve in the military for some years after they graduate.

tucan54: "As a retired vet from the Air Force and also a disabled vet (rated 100% disabled in line of duty) I will lose between 22 & 23 percent of my health care benefits. That was in the CBO's report to Congress.... Don't take my word for it, check it out yourselves - I did."

I would check it out for myself if you would supply a link to the CBO report, or the full name of the report. Forgive my cynicism, but somehow I suspect that even though you claim to have read the CBO report, you you won't supply either one.